Devices such as the MII Ret Cam (MII Ret Cam Inc, Coimbatore, TN, India) have revolutionised smartphone based retinal imaging [1]. The affordability, portability and connectivity has popularised smartphone based retinal imaging beyond all boundaries. They are becoming increasingly popular in retinal imaging for patient records, academic purposes and also for medico-legal reasons. There are several studies using smart phones to image the retina in diabetic retinopathy (DR) screening and optic disc in glaucoma screening [1,2,3]. Ophthalmologists are now finding its utility in retinopathy of prematurity (ROP) screening. Review of literature reveals that there are several studies already in smartphone based retinopathy of prematurity (S-ROP) screening [4]. There are, however, certain limitations and challenges with S-ROP screening that has prevented it from being embraced by the ophthalmic fraternity as the mainstay tool in ROP screening. On a brighter note, the advanced imaging platforms with the newer smart phones and their adaptability has also opened up several opportunities for research and development. This has paved way for the integration with novel concepts of artificial intelligence (AI) and 3D printing technology [5,6,7,8].

The greatest boon of the S-ROP screening has been its cost effectiveness. Policy makers would love the option of S-ROP screening given its low-cost, one-time investment, nil maintenance and repairs. With financial constraints in the lower and middle-income economies, any investment in ROP screening and imaging is considered an additional and un-called burden that could only serve a small population. In total, 3.5 million babies are born premature in India alone and the scale of the problem is much higher in the Sub-Saharan Africa [9]. Given the magnitude of ROP-related blindness in the developing world, any investment towards ROP screening should be considered imperative and of vital health-care importance. It is of general belief amongst the hospital management that the limited resources instead could be more efficiently utilised in other areas of ophthalmic practice that could subserve a larger population such as management of cataract blindness or due to DR and Glaucoma. S-ROP is the only feasible solution in terms of health economics at the moment for this problem. S-ROP screening also facilitates tele-ophthalmology with real-time transfer of images to a treating referral centre, thanks to the various apps that support these functions. Hence, S-ROP could be easily carried out in the peripheral units in remote and rural settings with a team of non-ophthalmic personnel such as technicians or nurses trained in image acquisition. There are no logistical barriers of moving a heavy, large piece of equipment by the screening team. The procedure is also considered to be less distressing for the baby as it is a non-contact procedure. This also minimises any risk of infection, as it does not involve any imaging probes. We have published a similar pilot model in the recent past [10]. Furthermore, it also allows for the imaging to be carried out in lower light exposure when compared with an indirect ophthalmoscope [11].

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